Clearinghouses are third-party service providers that act as intermediaries between healthcare providers and health insurance companies. Their primary function is to process and route electronic claims, ensuring they are formatted correctly and meet the payer's requirements. When a healthcare provider submits a claim to a Clearinghouse, the Clearinghouse will review the claim to make sure it is complete and compliant with the payer's requirements. They will then forward the claim to the appropriate payer for payment. If the claim is denied or rejected, the Clearinghouse will provide the healthcare provider with information on why the claim was rejected so that the provider can make the necessary corrections and resubmit the claim. 

While Clearinghouses can help ensure that claims are formatted correctly and routed to the appropriate payer, they do not provide a comprehensive solution for managing your billing and revenue cycle. Many practices find that using a Clearinghouse can be time-consuming and frustrating, as they often require manual data entry and can result in rejected claims, leading to delays in payment and reduced revenue.

Explore the pros and cons of using a Medical Billing Clearinghouse vs. a Revenue Cycle Management Service—read the full article here: [ Ссылка ]?

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